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Abstract

Gender bias has implications in the treatment of both male and female patients and it is important to take into consideration in most fields of medical research, clinical practice and education. Gender blindness and stereotyped preconceptions about men and women are identified as key causes to gender bias. However, exaggeration of observed sex and gender differences can also lead to bias. This article will examine the phenomenon of gender bias in medicine, present useful concepts and models for the understanding of bias, and outline areas of interest for further research.
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... In this regard, the debate is extremely heterogeneous in both terms and concepts, and several models have been proposed to account for the different types of gender biases in medicine (Ruiz and Verbrugge, 1997;Risberg et al., 2009) 1 . A way to efficiently disentangle the scholarship is to distinguish -by adapting the models of Ruiz and Verbrugge (1997) and Risberg and colleagues (2009) in light of the blindness versus stereotyping dichotomy proposed by Hamberg (2008), Verdonk and colleagues (2009), and Marcum (2015) between two forms of bias: i) gender blindness, by assuming equality between women and men when there is none; that is, by assuming that diseases' risks, symptoms and progression are equal for men and women 2 ; ii) gender stereotyp- ...
... Men are treated more extensively than women with equal symptoms in a variety of diseases (Hamberg, 2008;Mauvais-Jarvis et al., 2020). At the same time, sex and gender differences in symptoms are sometimes neglected (gender blindness). ...
... Following their work,Risberg and colleagues (2009) identified two dichotomous 'axes' producing biases: sameness/difference and equity/inequity. At the same time,Hamberg (2008) listed different types of gender biases including «gender blindness» and «stereotyped preconceptions», while the term «gender stereotyping» has been used by collegues (2009) andMarcum (2015).2 The term «gender blindness» is used here in a very specific way: to describe a specific form of bias leading researchers and clinicians to ignore gender differences. ...
Article
While gender mainstreaming in research has been systematically supported at the institutional level, most especially by the European Commission through its funding schemes, less attention has been drawn to academic teaching. However, gendering education is an equally essential pillar to take care of, given that it is in universities that future researchers and scientists are currently educated and trained. Focusing on the case study of medicine, this paper aims to give an account of what a gender-blind approach to science is, and what biases it entails at different levels of biomedical practice, from knowledge production (research) to its transfer (clinical practice) and teaching (education and training). To do so, an interdisciplinary literature review – ranging from the health to the social sciences – has been undertaken with the aim of constructing a conceptual framework that could help to map and classify the various forms of sex and gender bias in medicine. A few good international practices aimed at debiasing academic curricula in medical schools will be described as well. In this regard, the efforts made in the domain of higher education remain fragmented and limited to a single country or organisation-based initiatives, while a more systematic approach should be encouraged.
... Women use health care services, in general, more frequently than men [15,[52][53][54][55] but report to have more unmet health care needs within conventional health care than men [52]. This may be the reason why women choose to use CAM to a higher degree than men [7,56,57]. ...
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Background Research exploring the use of specific Complementary and Alternative Medicine (CAM) modalities by Norwegian cancer patients is sparse. The aims of this study were therefor to map the different CAM modalities cancer patients use and further investigate their rationale for use, communication about use, self-reported benefits and harms, and their sources of information about the different modalities. Methods In cooperation with the Norwegian Cancer Society (NCS), we conducted an online cross-sectional study among members of their user panel with present or previously cancer (n = 706). The study was carried out in September/October 2021 using a modified cancer-specific version of the International Questionnaire to Measure Use of Complementary and Alternative Medicine (I-CAM-Q). In total, 468 members, 315 women and 153 men, agreed to participate resulting in a response rate of 67.2%. The study was reported in accordance with the National Research Center in Complementary and Alternative Medicine’s (NAFKAM) model of reporting CAM use. Results A large proportion of the participants (79%, n = 346) had used some form of CAM with a mean of 3.8 modalities each (range 1-17); 33% (n = 143) had seen a CAM provider, 52% (n = 230) had used natural remedies, while 58% (n = 253) had used self-help practices. Most of the participants used CAM to increase their quality of life, cope with the cancer disease or for relaxation/well-being (64%-94%), mostly with high satisfaction and low rates of adverse effects. Few used CAM to treat cancer or prevent it from spreading (16%, n = 55). The main information sources were health care providers (47%), the internet (47%), and family and friends (39%). More than half (59%) of the cancer patients discussed their use of at least one CAM modality with a physician. Conclusions The results of this survey will provide health professionals with more in-depth insight into the patterns of CAM use by cancer patients and facilitate better-informed discussions with their patients. Considering the high use of CAM, reliable information provision supporting cancer care providers’ knowledge and health literacy among patients as well as good communication are crucial. The cooperation between the NCS and NAFKAM provides an example of how to address these issues.
... Patient gender was also found to be significantly associated with patients' responses, being that more than half of the male patients stated that they received an adequate explanation and had their doubts clarified regarding the procedures performed by students, while this was only the case for less than a quarter of female patients. Even though some studies suggest that women tend to be more open to bedside teaching [25], the literature also shows that women are not offered the same treatment as men when it comes to healthcare [26]. Despite all efforts to fight gender bias, this result might directly reflect a cultural situation perpetuating gender inequality. ...
... Patient gender was also found to be significantly associated with patients' responses, being that more than half of the male patients stated that they received an adequate explanation and had their doubts clarified regarding the procedures performed by students, while this was only the case for less than a quarter of female patients. Even though some studies suggest that women tend to be more open to bedside teaching [25], the literature also shows that women are not offered the same treatment as men when it comes to healthcare [26]. Despite all efforts to fight gender bias, this result might directly reflect a cultural situation perpetuating gender inequality. ...
Article
There are complex ethical dilemmas inherent to medicine teaching, particularly in clinical practice involving actual patients. Questions must be raised on fulfilling medical students’ training needs while still respecting patients’ fundamental rights to autonomy and privacy. We aimed to assess patients’ perspectives regarding medical students’ involvement in their medical care. An observational, cross-sectional study was developed, and a questionnaire was applied randomly to patients waiting for a consultation/admitted to three distinct departments: General Surgery, Obstetrics/Gynaecology, and Infectious Diseases. Of the 77% interviewed patients who reported previous experiences with medical students, only 59% stated that they were asked for consent for their participation, and 28% stated that students had adequately introduced themselves. Patients from Gynaecology/Obstetrics were the ones who reported lower rates of these practices and were also the ones who were most bothered by students’ presence, stating that they would be more comfortable without the presence of medical students. Male patients received more explanations than female patients regarding the same matters. Thirty-five percent of patients stated that they would feel more comfortable without the medical students’ presence. The study shows a need to pay closer attention to fulfilling patients’ fundamental rights.
... The broader literature denotes that there may be gender bias in medicine that leads to stereotypical responses to tasks and roles that can impact power, and economic and social prosperity [25]. Women GPs may frame their work identity to conform to gendered expectations despite this playing out negatively for their financial and professional status [26]. ...
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Background Worldwide, the proportion of women entering careers in medicine is increasing. To ensure diversity and capacity in the general practice (“GP”) supervision workforce, a greater understanding from the perspective of women GPs engaged in or considering the clinical supervision of trainee doctors is important. This narrative inquiry aims to explore the uptake and sustainability of supervision roles for women GPs in the Australian context. Methods Qualitative interviews with Australian women GPs were conducted between July and September 2021. Women GPs were selected to represent a range of demographics, practice contexts, and supervision experience to promote broad perspectives. Narrative analysis drew on participant perspectives, allowing emergent stories to be explored using story arcs based on the characters, settings, problems, actions, and resolutions. These stories were evaluated by a broad research team and a high level of agreement of the final narratives and counter-narratives was achieved. Results Of the 25 women who enrolled, 17 completed interviews. Six narratives emerged, including: power and control, pay, time, other life commitments, quality of supervision, and supervisor identity. These represented significant intersecting issues with the potential to impact the uptake and sustainability of supervision by women GPs. Some women GPs reported a lack of agency to make decisions about their role in supervision and were not remunerated for teaching. Uptake and sustainability of supervision was constrained by other life commitments, which could be buffered by team-sharing arrangements and a supportive practice. Although adding a burden of time atop their complex and sensitive consultations, women GPs were committed to being available to registrars and supervising at a high standard. To foster high quality supervision, women GPs were interested in up-skilling resources, building experience and harnessing support networks. Women sensed imposter syndrome when negotiating a supervisor identity, which could be managed by explicitly valuing their contribution. Conclusion The findings can inform the development of more specific resources, supports and structures to enable women GPs in Australia to uptake and sustain the supervision of trainee doctors at a level they find both acceptable and rewarding.
Chapter
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Globally, vascular diseases are a leading cause of morbidity and mortality. Many of the most significant risk factors for vascular disease have a gendered dimension, and sex differences in vascular diseases incidence are apparent, worldwide. In this narrative review, we provide a contemporary picture of sex and gender-related determinants of vascular disease. We illustrate key factors underlying sex-specific risk stratification, consider similarities and sex differences in vascular disease risk and outcomes comparing data from the global North (i.e., developed high income countries in the Northern hemisphere and Australia) and the global South (i.e., regions outside Europe and North America), and explore the relationship between country-level gendered inequities in vascular disease risk and the United Nation’s gender inequality index. Review findings suggest that the rising incidence of vascular disease in women is partly explained by an increase in the prevalence of traditional risk factors linked to gender-related determinants such as shifting roles and relations related to the double burden of employment and caregiving responsibilities, lower educational attainment, lower socioeconomic status, and higher psychosocial stress. Social isolation partly explained the higher incidence of vascular disease in men. These patterns were found to be apparent across the global North and South. Study findings emphasize the necessity of taking into account sex differences and gender-related factors in the determination of the vascular disease risk profiles and management strategies. As we move towards the era of precision medicine, future research is needed that identifies, validates and measures gender-related determinants and risk factors in the global South.
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The healthcare sector has been an early adopter of new technologies such as artificial intelligence, nanotechnology, or genome sequencing. They are expected to improve healthcare systems and augment practitioners’ skills. The deployment of wearable sensors and healthcare trackers are empowering individuals, making them self-aware of their wellbeing but also turning them into data donors. Personal data are essential to train machine learning models used to support healthcare professionals in decision making. However, it is extremely relevant to consider the power of the (mis-)represented population in the data analyzed. Artificial intelligent systems used in precision medicine need to be robust, not only technically but also socially by tackling gender imbalance, technology access, or other issues that may affect vulnerable groups in healthcare. This chapter offers an overview on the opportunities of digital health ecosystems while highlighting some social, ethical, and technical challenges. It also provides a review of the relation of the traditional ethical principles used in health and biomedicine and those defined for the design, deployment, and use of a trustworthy AI in Europe.
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Gender awareness in medicine consists of two at-titudinal components: gender sensitivity and gender-role ideology. In this article, the development of a scale to measure these attitudes in Dutch medical students is described. After a pilot study and a feasibility study, 393 medical students in The Netherlands responded to a preliminary instrument consisting of 82 items (response rate 61.3%). Reliability and validity were established. A gender awareness scale containing a gender sensitivity subscale (14 items), and gender stereotypes towards patients (11 items) as well as towards doctors (7 items) was developed. The instrument may be used for research purposes to evaluate gender awareness raising courses.
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The feminist movement was from its start in the 19th century involved in the struggle for better health care for women. The first feminists aimed at better information on birth control and sexuality. The second feminist wave focused on the unequal division of power roles between men and women. A lot of the problems women experienced could be seen as a consequence of their subordinate role in society. At the end of the 1980s and in the 1990s, the discipline women and health or women and medicine was developed. In this introduction to the theme, the developments in this discipline are described. The starting points of the new discipline followed the principles of ‘women’s health care’. These principles can be summarized as the emphasis on control and autonomy by the patient, demedicalization, the importance of the psychosocial context of complaints, empowerment of women and good information and communication. The central issue of the article is: what is the actual scientific state of the art and what important changes have been made on the subject gender and health? The article ends with ideas for future research.
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A n n e F a u s t o -S t e r l i n g The Bare Bones of Sex: Part 1—Sex and Gender H ere are some curious facts about bones. They can tell us about the kinds of physical labor an individual has performed over a lifetime and about sustained physical trauma. They get thinner or thicker (on average in a population) in different historical periods and in response to different colonial regimes (Molleson 1994; Larsen 1998). They can in-dicate class, race, and sex (or is it gender—wait and see). We can measure their mineral density and whether on average someone is likely to fracture a limb but not whether a particular individual with a particular density will do so. A bone may break more easily even when its mineral density remains constant (Peacock et al. 2002). 1 Culture shapes bones. For example, urban ultraorthodox Jewish ado-lescents have lowered physical activity, less exposure to sunlight, and drink less milk than their more secular counterparts. They also have greatly decreased mineral density in the vertebrae of their lower backs, that is, the lumbar vertebrae (Taha et al. 2001). Chinese women who work daily in the fields have increased bone mineral content and density. The degree of increase correlates with the amount of time spent in physical activity (Hu et al. 1994); weightlessness in space flight leads to bone loss (Skerry 2000); gymnastics training in young women ages seventeen to twenty-seven correlates with increased bone density despite bone resorption caused by total lack of menstruation (Robinson et al. 1995). Consider also some recent demographic trends: in Europe during the past thirty years, the number of vertebral fractures has increased three-to fourfold for women and more than fourfold for men (Mosekilde 2000); in some Thanks to the members of the Pembroke Seminar on Theories of Embodiment for a wonderful year of thinking about the process of body making and for their thoughtful response to an earlier draft of this essay. Credit for the title goes to Greg Downey. Thanks also to anonymous reviewers from Signs for making me sharpen some of the arguments. 1 Munro Peacock et al. write: "The pathogenesis of a fragility fracture almost always involves trauma and is not necessarily associated with reduced bone mass. Thus, fragility fracture should neither be used synonymously nor interchangeably as a phenotype for os-teoporosis" (2002, 303).
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Gender awareness in medicine consists of two attitudinal components: gender sensitivity and gender-role ideology. In this article, the development of a scale to measure these attitudes in Dutch medical students is described. After a pilot study and a feasibility study, 393 medical students in The Netherlands responded to a preliminary instrument consisting of 82 items (response rate 61.3%). Reliability and validity were established. A gender awareness scale containing a gender sensitivity subscale (14 items), and gender stereotypes towards patients (11 items) as well as towards doctors (7 items) was developed. The instrument may be used for research purposes to evaluate gender awareness raising courses.
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It is conventional wisdom in medical sociology and social epidemiology that in industrialized societies men die earlier than women, but that women have poorer health than men. A number of explanations for these differences have been postulated and tested (for example, different biological risks, acquired risks, reporting biases and experiences of health care). Using two recent British data sets we find that the pattern of sex differences in morbidity is more complicated than the conventional wisdom often suggests. The direction and magnitude of sex differences in health vary according to the particular symptom or condition in question and according to the phase of the life cycle. Female excess is only consistently found across the life span for psychological distress and is far less apparent, or reversed, for a number of physical symptoms and conditions. Detailed inspection of papers on gender differences published in the last decade reveals that our findings are not unique, but that a relatively undifferentiated model of consistent sex differences has nevertheless continued to predominate in the literature. We believe that the topic of gender differences in health warrants periodic re-examination.
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RECENT evidence has raised concerns that women are disadvantaged because of inadequate attention to the research, diagnosis, and treatment of women's health care problems. In 1985, the US Public Health Service's Task Force on Women's Health Issues reported that the lack of research data on women limited understanding of women's health needs.1 One concern is that medical treatments for women are based on a male model, regardless of the fact that women may react differently to treatments than men or that some diseases manifest themselves differently in women than in men. The results of medical research on men are generalized to women without sufficient evidence of applicability to women.2-4 For example, the original research on the prophylactic value of aspirin for coronary artery disease was derived almost exclusively from research on men, yet recommendations based on this research have been directed to